This form contains 110 fields organized into 22 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Collect on Delivery Information
Collect on Delivery Amount Number
Provide the monetary amount to be collected upon delivery.
Max length: 10 characters
Remit to Name Text
Enter the name of the party to whom the Collect on Delivery funds should be remitted. Fill only if 'Collect on Delivery Amount' has a monetary value.
Max length: 25 characters
Depends on: Collect on Delivery Amount
Remit to Street Address Text
Enter the street address for remitting the Collect on Delivery funds. Fill only if 'Collect on Delivery Amount' has a monetary value.
Max length: 28 characters
Depends on: Collect on Delivery Amount
Remit to City Text
Enter the city for remitting the Collect on Delivery funds. Fill only if 'Collect on Delivery Amount' has a monetary value.
Max length: 15 characters
Depends on: Collect on Delivery Amount
Remit to State Text
Enter the state for remitting the Collect on Delivery funds. Fill only if 'Collect on Delivery Amount' has a monetary value.
Max length: 2 characters
Depends on: Collect on Delivery Amount
Consignee Information
Consignee Name Text
Please enter the full name of the consignee (the party to whom the shipment is being delivered).
Max length: 55 characters
Consignee Phone Number Text
Please provide the phone number of the consignee.
Max length: 25 characters
Consignee Reference Number
Consignee Reference / PO Number Text
Provide the consignee's reference number or purchase order number.
Max length: 18 characters
Declared Value
Declared Value Amount Number
Enter the maximum declared value of the property.
Max length: 7 characters
Declared Value Unit Text
Enter the unit of measure for the declared value, such as 'pound' or 'package'.
Max length: 8 characters
Delivering Carrier
Delivering Carrier Text
Enter the name of the delivering carrier responsible for transporting the shipment.
Max length: 70 characters
Destination Address
Destination Street Text
Enter the street address for the destination.
Max length: 70 characters
Destination City Text
Enter the city for the destination.
Max length: 35 characters
Destination State Text
Enter the state abbreviation for the destination.
Max length: 2 characters
Destination Zip Code Text
Enter the ZIP code for the destination.
Max length: 10 characters
Eighth Shipping Item
Eighth Item Weight Number
Enter the total weight in pounds for the eighth shipping item, subject to correction.
Max length: 7 characters
Eighth Item Handling Units No Type Text
Enter the number and type of handling units for the eighth shipping item.
Max length: 7 characters
Eighth Item Number of Packages Number
Enter the number of packages for the eighth shipping item.
Max length: 7 characters
Eighth Item Class or Rate Text
Enter the freight class or rate applicable to the eighth shipping item.
Max length: 7 characters
Eighth Item Description Text
Provide a description of the kind of package, articles, special marks, and any exceptions for the eighth shipping item.
Max length: 60 characters
Eighth Item Cube Text
Enter the cubic dimensions for the eighth shipping item, if applicable.
Max length: 7 characters
Fifth Shipping Item
Number of Packages Number
Enter the total number of packages for the fifth shipping item.
Max length: 7 characters
Handling Units Type Text
Provide the type of handling units for the fifth shipping item.
Max length: 7 characters
Item Description Text
Describe the kind of package, articles, and any special marks or exceptions for the fifth shipping item.
Max length: 60 characters
Weight in Pounds Number
Enter the weight in pounds for the fifth shipping item, subject to correction.
Max length: 7 characters
Class or Rate Text
Provide the freight class or applicable rate for the fifth shipping item.
Max length: 7 characters
First Shipping Item
Number of Packages Number
Enter the total number of packages for this shipping item.
Max length: 7 characters
Handling Unit Type Text
Specify the type of handling unit or hazardous material code for this shipping item.
Max length: 7 characters
Package and Article Description Text
Provide a detailed description of the package type, articles contained, and any special marks or exceptions for this shipping item.
Max length: 60 characters
Weight in Pounds Number
Enter the total weight of this shipping item in pounds.
Max length: 7 characters
Freight Class or Rate Text
Provide the freight class or applicable rate for this shipping item.
Max length: 7 characters
Fourth Shipping Item
Fourth Item Number of Packages Number
Enter the total number of packages for the fourth shipping item.
Max length: 7 characters
Fourth Item Handling Units Text
Enter the handling units and type for the fourth shipping item.
Max length: 7 characters
Fourth Item HM Indicator Text
Indicate if the fourth shipping item contains hazardous materials.
Max length: 60 characters
Fourth Item Weight Number
Enter the weight of the fourth shipping item in pounds, subject to correction.
Max length: 7 characters
Fourth Item Freight Class or Rate Number
Enter the freight class or rate applicable to the fourth shipping item.
Max length: 7 characters
Freight Bill Address
Company Name Text
Please enter the full legal name of the company to which the freight bill should be sent.
Max length: 48 characters
Street Address Text
Please enter the street address where the freight bill should be sent.
Max length: 35 characters
City Text
Please enter the city where the freight bill should be sent.
Max length: 20 characters
State Text
Please enter the state where the freight bill should be sent.
Max length: 2 characters
Zip Code Text
Please enter the zip code for the freight bill address.
Max length: 10 characters
General
COD Fee Paid by Shipper Checkbox
Check this box if the C.O.D. (Cash on Delivery) fee is to be paid by the shipper. Fill only if 'Collect on Delivery Amount' has a monetary value.
Depends on: Collect on Delivery Amount
COD Fee Paid by Consignee Checkbox
Check this box if the C.O.D. (Cash on Delivery) fee is to be paid by the consignee. Fill only if 'COD Fee Paid by Shipper' has a monetary value.
Depends on: COD Fee Paid by Shipper
Consignee's Check OK Checkbox
Check this box to indicate that the consignee's check is an acceptable form of payment for the C.O.D. fee. Fill only if 'Collect on Delivery Amount' has a monetary value.
Depends on: Collect on Delivery Amount
Hazardous Material Line 1 Checkbox
Check this box if the package described on this line contains hazardous materials.
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Class or Rate Row 1 Number
Enter the classification or rate for the first item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 2 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 2 Number
Enter the classification or rate for the second item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 3 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 3 Number
Enter the classification or rate for the third item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 4 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 4 Number
Enter the classification or rate for the fourth item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 5 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 5 Number
Enter the classification or rate for the fifth item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 6 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 6 Number
Enter the classification or rate for the sixth item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 7 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 7 Number
Enter the classification or rate for the seventh item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Hazardous Material Line 8 Checkbox
Check this box if the package described on this line contains hazardous materials.
Class or Rate Row 8 Number
Enter the classification or rate for the eighth item listed.
85 60 200 70 250 92.5 125 175 110 400 ______ 300 500 77.5 55 65 100 150 50
Freight Charges Collect Checkbox
Check this box if the freight charges are to be collected from the consignee upon delivery, rather than being prepaid.
Stretch Wrapped Yes Checkbox
Check this box if the shipment is stretch-wrapped.
Stretch Wrapped No Checkbox
Check this box if the shipment is not stretch-wrapped.
Ninth Shipping Item
Ninth Item Weight Number
Please enter the weight in pounds for the ninth shipping item, subject to correction.
Max length: 7 characters
Problem Notification Contact
Contact Name Text
Please provide the full name of the contact person to be notified if there is a problem en route or at delivery.
Max length: 25 characters
Contact Fax Text
Please provide the fax number of the contact person to be notified if there is a problem en route or at delivery.
Max length: 14 characters
Contact Phone Text
Please provide the phone number of the contact person to be notified if there is a problem en route or at delivery.
Max length: 20 characters
Second Shipping Item
Number of Packages Text
Provide the total count of packages for this specific shipping item.
Max length: 7 characters
Handling Units Type Text
Specify the number and type of handling units associated with this shipping item.
Max length: 7 characters
Package and Article Description Text
Enter a comprehensive description of the package kind, articles contained, special marks, and any exceptions for this shipping item.
Max length: 60 characters
Item Weight Number
Enter the weight of this shipping item in pounds.
Max length: 7 characters
Item Cubic Measurement Number
Enter the cubic measurement for this shipping item, if applicable.
Max length: 7 characters
Seventh Shipping Item
Seventh Item Weight Number
Enter the total weight in pounds for the seventh shipping item.
Max length: 7 characters
Seventh Item Number of Packages Number
Enter the total number of packages for the seventh shipping item.
Max length: 7 characters
Seventh Item Handling Unit Type Text
Enter the type of handling units used for the seventh shipping item, such as cartons or pallets.
Max length: 7 characters
Seventh Item Hazardous Material Text
Indicate if the seventh shipping item is a hazardous material, typically by marking 'X'.
Max length: 60 characters
Seventh Item Class or Rate Text
Enter the freight class or applicable rate for the seventh shipping item.
Max length: 7 characters
Seventh Item Cube Number
Enter the total cubic measurement for the seventh shipping item if applicable.
Max length: 7 characters
Shipment Counts
Package Count Number
Enter the total number of packages included in this shipment.
Max length: 4 characters
Pallet Count Number
Enter the total number of pallets included in this shipment.
Max length: 4 characters
Number of Shipments Number
Enter the total number of individual shipments.
Max length: 4 characters
Shipper Address
Shipper Name Text
Enter the full name of the shipper or the shipper's company.
Max length: 70 characters
Street Address Text
Provide the street number and name for the shipper's address.
Max length: 30 characters
City Text
Enter the city for the shipper's address.
Max length: 25 characters
State Text
Provide the two-letter state abbreviation for the shipper's address.
Max length: 2 characters
Zip Code Text
Enter the postal zip code for the shipper's address.
Max length: 10 characters
Shipper Bill of Lading Number
Shipper Bill of Lading Number Text
Enter the unique identifying number for this shipper's bill of lading.
Max length: 15 characters
Shipper Certification
Shipper Signature/Initials Text
Provide the shipper's signature or initials to officially certify the information provided in the bill of lading.
Max length: 30 characters
Signatory Name Text
Enter the printed name of the individual who is signing and certifying the bill of lading on behalf of the shipper.
Max length: 30 characters
Certification Date Date
Provide the date when the shipper's certification and signature were applied to the document.
Max length: 15 characters
Certification Time Time
Enter the time when the shipper's certification and signature were applied to the document.
Max length: 10 characters
Sixth Shipping Item
Sixth Shipping Item Class or Rate Text
Please provide the class or rate for the sixth shipping item.
Max length: 7 characters
Sixth Shipping Item Number of Packages Number
Please enter the total number of packages for the sixth shipping item.
Max length: 7 characters
Sixth Shipping Item Handling Units Type Text
Please specify the type of handling units for the sixth shipping item.
Max length: 7 characters
Sixth Shipping Item Package and Article Description Text
Please provide a detailed description of the kind of package, articles, special marks, and any exceptions for the sixth shipping item.
Max length: 60 characters
Sixth Shipping Item Weight Number
Please enter the weight in pounds for the sixth shipping item.
Max length: 7 characters
Sixth Shipping Item Cube Number
Please enter the cubic measurement for the sixth shipping item.
Max length: 7 characters
Third Shipping Item
Third Item Number of Packages Number
Enter the total number of packages for the third shipping item.
Max length: 7 characters
Third Item Handling Units Number and Type Text
Specify the number and type of handling units for the third shipping item.
Max length: 7 characters
Third Item Package Description Text
Provide a detailed description of the kind of package, articles, and any special marks or exceptions for the third shipping item.
Max length: 60 characters
Third Item Weight in Pounds Number
Enter the total weight of the third shipping item in pounds.
Max length: 7 characters
Third Item Cube (Optional) Number
Enter the cubic measurement of the third shipping item if applicable.
Max length: 7 characters